A comparative study of anatomical single-bundle anterior cruciate ligament reconstruction using femoral offset aimer versus freehand technique for femoral tunnel preparation
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ACL reconstruction is one of the commonest orthopaedic procedures performed. There has been a shift in techniques from single bundle to double bundle to anatomic single-bundle reconstruction and also from transtibial to anteromedial method. Anteromedial technique results in more anatomic femoral tunnel with graft positioned at the native insertion site. The tunnel position is crucial for better outcome after ACL reconstruction.
To compare the femoral tunnel position made by anatomic single-bundle ACL reconstruction using femoral offset aimer device versus freehand drilling with 3D computed tomography.
A prospective case series involving 60 patients with ACL tear who underwent anteromedial single-bundle ACL reconstruction.
Computed tomography scans were performed on 60 knees that underwent single-bundle anteromedial ACL reconstruction with 30 cases involving femoral drilling through aimer device and another 30 cases involving freehand drilling of the tunnel. Three-dimensional models were created, and the data were analysed according to the co-ordinate axes method. Femoral tunnel position was measured in proximal-to-distal and posterior-to-anterior directions. Data from both the groups were compared with each other and already published reference data on anatomical tunnel position.
In the aimer group, the femoral tunnel centre on the medial wall of lateral femoral condyle was located at 35 ± 9% in the posterior-to-anterior direction and at 30 ± 12% in the proximal-to-distal direction. In the freehand group, tunnel was placed at 37 ± 10% in posterior-to-anterior and 28 ± 7% in proximal-to-distal directions. There was no significant difference in tunnel position in both the groups.
This study shows there is no significant difference between both the drilling techniques of femoral tunnel, i.e. freehand drilling and drilling with aimer device. Also, it reiterates the efficacy and utility of computed tomography and three-dimensional reconstruction in the analysis of femoral tunnel in ACL reconstruction.
KeywordsAnterior cruciate ligament reconstruction technique Anatomical Femoral tunnel Computed tomography 3D reconstruction Co-ordinate axes method Freehand technique Aimer
This study was not funded and received no grants.
Compliance with ethical standards
Conflict of interest
Both the authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.